Provider Demographics
NPI:1265736961
Name:FERRO, KYLE DAVID (DDS)
Entity type:Individual
Prefix:DR
First Name:KYLE
Middle Name:DAVID
Last Name:FERRO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 HOLLY RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75605-2500
Mailing Address - Country:US
Mailing Address - Phone:225-252-1185
Mailing Address - Fax:
Practice Address - Street 1:1100 STONE RD
Practice Address - Street 2:SUITE 265
Practice Address - City:KILGORE
Practice Address - State:TX
Practice Address - Zip Code:75662-5482
Practice Address - Country:US
Practice Address - Phone:903-984-3597
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-10
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX26233122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist